Provider Demographics
NPI:1043258825
Name:PAN, ALAN SEOW-MENG (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:SEOW-MENG
Last Name:PAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SEOW MENG
Other - Middle Name:
Other - Last Name:PHUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:951-571-8518
Mailing Address - Fax:877-778-9427
Practice Address - Street 1:24853 ALESSANDRO BLVD
Practice Address - Street 2:#4
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-6104
Practice Address - Country:US
Practice Address - Phone:951-571-8518
Practice Address - Fax:877-778-9427
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01363671OtherRAILROAD MEDICARE-DU4034
CACA115029Medicare PIN
CA20A59640Medicare PIN
CAF18623Medicare UPIN